Does Hormone Therapy Affect Mood During Menopause Transition?

Summary: Yes, hormone therapy can affect mood during menopause transition. New research analyzes the impact of hormone therapy (HT) on psychological/mental health and sleep subscales on a standardized assessment of menopause symptom severity.

Key Points:

• Transition to menopause typically occurs during the mid-40s but may begin as early as the late 30s.
• The transition is called perimenopause and may last months to years before the official beginning of menopause, i.e. the phase of life after reproductive capacity.
• Many symptoms of menopause are physical, such as hot flashes and night sweats, but symptoms often include changes in mood and sleep.

Mood and Sleep During Transition to Menopause (Perimenopause)

In the peer-reviewed research publication “Impact of Hormone Therapy on Mood n A Real-World Clinical Setting: A Retrospective Observational Study,” an all-female group of physicians and researchers designed a study they describe as follows:

“This retrospective, comparative study evaluated the impact of systemic HT on mood in a cohort of HT-naive individuals.”

Many people have heard of menopause, and most understand it as the time of life for women after changes in their bodies end their ability to produce hormones that enable them to bear children. That’s true, and the phase called perimenopause is the transitional time between child-bearing years and post-childbearing years, which includes the onset of a host of uncomfortable and disruptive symptoms.

In addition to hot flashes and night sweats, studies show that over 2/3rds of women – 68 percent – report symptoms associated with mood and sleep. Here’s what they may experience:

• Depressed mood
• Irritability
• Anxiety
• Mental exhaustion
• Sleep disturbance

To assess the impact of hormone therapy on these symptoms, the research team on the study recruited a group of participants with the following characteristics:

• Total participants: 260
• Average age: 52
• Previous mental health history:
  • 51% had either anxiety or depression before beginning HT
  • 24% took antidepressant medication before beginning HT
• All participants completed the menopause rating scale before and after beginning HT
• Study duration: 2023-2025

The researcher team analyzed responses to sections of the menopause rating scale that asked questions about:

• Depression
• Irritability
• Anxiety
• Mental exhaustion
• Sleep quality

Let’s take a look at what they found.

Outcomes: Hormone Therapy (HT) and Menopause Transition Symptoms

The researcher team consolidated the sections of the menopause rating scale on mental health factors into a consolidated score they called mood. They further stratified those scores into groups labeled mild and severe, in order to compare the impact of HT on women from pre-treatment to post-initiation by baseline severity of mood issues or disturbances.

In addition, researchers analyzed any change in the composite score on the menopause rating scale. The composite score is a single numeric value meant to represent the overall impact of symptoms of menopause on an individual.

We’ll report what they found, starting with the effect of hormone therapy on mood.

Impact of HT on Mood During Menopause Transition

Overall:

• Statistically significant reduction in mood scores
• By severity:
  • Severe mood disturbance at baseline: 62.3%
  • Severe mood disturbance at follow-up: 24.6%
• Possible confounding factors:
  • Psychiatric history: no impact
  • Age: no impact
  • Stage of menopause: no impact
  • Use of antidepressants: no impact

When stratified by baseline severity:

• Severe mood symptoms: 3.85 point reduction
• Moderate mood symptoms: 0.89 point reduction
• Mild mood symptoms: 0.47 point reduction

Possible confounders:

• Use of antidepressants: no impact
• Presence of anxiety diagnosis: no impact
• Presence of depression diagnosis: no impact
• Race: no impact
• Menopausal stage: no impact
• Age: no impact

Those results show that for women new to hormone therapy, treatment can improve symptoms associated with mood. Previous presence of mental health disorders – depression and anxiety – did not affect improvements in mood associated with HT.

Now let’s look at the impact of hormone therapy on sleep.

Impact of HT on Sleep During Menopause Transition

• Sleep scores improved from baseline to follow-up:
  • 1 point improvement

For people with chronic sleep disturbance, any improvement makes a subjective difference and can impact overall wellbeing.

• Possible confounders:
  • Use of antidepressants: no impact
  • Presence of anxiety: no impact
  • Presence of depression: no impact
  • Race: no impact
  • Menopausal stage: no impact
  • Age: no impact

These results show a minor improvement in sleep quality, which, in some cases, may be a significant change with real functional impact.

Finally, we’ll share the total – i.e. composite score change – impact of hormone therapy on scores on the menopause rating scale.

Impact of HT on Composite During Menopause Transition

• Composite scores improved from baseline to follow-up:
  • 23 point improvement
• Possible confounders:
  • Use of antidepressants: no impact
  • Presence of anxiety: no impact
  • Presence of depression: no impact
  • Race: no impact
  • Menopausal stage: no impact
  • Age: no impact

These results align with the scores on the mood category and the sleep category: HT can improve overall symptoms of perimenopause as measured by the menopause rating scale.

How This Information Can Help Our Patients

The study team characterizes the outcome of this research effort as follows:

“These findings suggest systemic HT may improve mood symptoms in midlife, especially among those with elevated baseline severity, independent of prior mental health diagnosis, antidepressant use, or menopause stage. These findings support further investigation of HT’s impact on mood in midlife women.”

For our female patients in midlife, this expands our understanding of the complex interplay between hormones, mood, transition to menopause, and menopause itself. Since symptoms of anxiety, depression, and sleep disturbance are common during the transition, individuals and providers can use this information to determine the nature and origin of their individual symptom profile, and tailor treatment and support accordingly.